/. Periodontal Res.

11: 35-46,, 1976

Correlation between gingival fluid

measurements and macroscopic and
microscopic characteristics
of gingival tissue
H. DANESHMAND AND A. BRYAN WADE
The Royal Dental Hospital of London, London, England

Thirty interdental sites in 30' subjects having varying degrees of periodontal inflammatory
disease were evaluated. A G.I. seore was recorded, crevicular fluid collected and measured,
pocket depths measured and biopsies undertaken. Two histological indices were devel-
oped, one hased on the extent of inflammatory cell infiltration and epithelial breakdown
(H.I.) the other on the number of extravasated inflammatory cells (LCI.). Low positive
correlations of about the same strength (r = 0.3) were found between both histological
indices and the G.I. and fluid measurements. No correlation at all was found between the
histological index and pocket depth, but there was a slight correlation between the in-
flammatory cell index and the depth of the pockets. A moderate correlation was found
between the amount of gingival fluid and G.I. scores. A low degree of correlation was
found when the G.I. was compared with pocket depths. The strongest relationship was
between the Histological Index and the Inflammatory Cell Index. It seems probable that
different indices evaluate different aspects of the inflammatory response. In studies of
small samples it may be wise to incorporate parameters which evaluate both macroscopic
and microscopic characteristics as. well as measurement of gingival fluid whenever practic-
able. For incidence and prevalence studies, however, a gingival index based on macro-
scopic criteria and measurements of pockets and loss of attachment are much simpler and
quicker than the collection, staining and measurement of gingival fluid, whilst histological
examination is usually impracticable.

(Received for publication April 4, 1975, accepted July 30, 1975)

Frank and Cimasoni (1972) state that it is
now generally agreed that the intensity of
gingival or crevicular fluid flow in man is
related to gingival inflammation and pocket
depth (Brill & Bjorn 1959, Maon 1963).
Clinical assessment of gingival inflamma-
tion depends on evaluation of changes in
colour, surface characteristics, texture, coo-
tour, consistency and bleeding tendency,
These determinations are subjective and,
therefore, susceptible to examiner varia-
bility.
Brill (1959a & b) suggested measuring
gingival fluid flow from the gingival pocket,
Brill and Krasse (1958 & 1959) and Brill
and Bjorn (1959) measured crevicular fluid
flow with filter paper strips inserted into
the crevice until resistance was felt. The
fluid flow increased in cases of gingivitis.
Brill's method has been used and evaluated
by several investigators. Mann (1963) found
a correlation between the amount of gin-
gival fluid, scores for gingival inflammation
and depths of the gingival crevices. Egelberg
 36 DANESHMAND
(1964) demonstrated a significant correlation
between crevicular fluid flow and inflam-
matory round cell infiltration in dogs using
planimetric methods during histological
evaluation. Bjorn et al. (1965) in a study of
170 subjects also found a highly significant
correlation between the amounts of gin-
gival exudate and the gingival index scores.
Loe and Holm-Pedersen (1965) reported
that healthy gingiva did not show a flow of
fluid, but that exudation commenced with
gingival inflammation and was proportional
to the degree of severity of the inflamma-
tion, they concluded that for obtaining valid
measurements, strips must be positioned at
the entrance and not within the crevice. Loe
et al. (1965) in a longitudinal study on the
development of gingivitis demonstrated that
gingival exudate could be measured hefore
clinical signs of inflammation were present
and it was suggested that gingival fluid
measurements provided a method for assess-
ing the sub-clinical state of the gingiva.
Oliver et al. (1969) have reaffirmed that
gingival exudate increases as gingivitis in-
creases; they have also stated that in healthy
gingiva, there is no fluid exudation from
the gingival crevice. Orban and Stallard
(1969) in a similar study concluded that
exudate scores were not related to the sev-
erity of gingivitis as assessed from biopsies.
Sandalli and Wade (1971) studied gingival
fluid in 52 young children of both sexes.
The amount of fluid revealed only a weak
correlation to the crevicular depth in the
absence of clinical signs of inflammation but
a much stronger correlation when the gin-
givae were inflamed. Since the fluid col-
lected in this research and others could be
due to irritation by the filter paper strips, it
has not been proved that gingival fluid is
present when the gingiva are healthy.
Golab, Borden and Kleinberg (1971),
however, concluded that estimation of the
urea concentration in gingival fluid was
inversely related to the severity of gingival
A N D BRYAN! W A D E
inflammation and might be used to eva-
luate the effectiveness of periodontal the-
rapy.
Wilson aod McHugh (1971) studied the
correlation between a gingival exudate index
and other indices of gingivitis. Forty-eight
subjects with healthy to moderately in-
flamed gingivae were examined, a modified
Oral Debris Index, Gingival Index and PMA
Index were recorded and gingival fluid flow
obtained by placing the paper just into the
entrance of the gingival crevice. The Gin-
gival Exudate Index was poorly correlated
with scores of other indices for the whole
mouth or for sample teeth but correlated
fairly well with the G.I. scores for the sites
from which the exudate was collected. They
concluded that a gingival exudate index is
no more reliable than the best subjective
indices or an oral debris index.
The results of their investigation did not
confirm those of previous investigators who
had found a significant correlation between
gingival exudate scores and gingivitis (Brill
1962, Bjorn et al. 1965, Sueda et al. 1965,
Oliver et al. 1969).
Previous workers inserted the filter paper
strips deeply into the gingival crevices until
resistance was felt (Egelberg 1964, Bjorn et
al. 1965). It has been demonstrated that
even gentle insertion of a filter paper strip
in the gingival crevice causes sufficient da-
mage to alter the permeability of the epi-
thelium so that the amount of gingival fluid
increases (Bgelberg 1967). Loe and Holm-
Pedersen (1965) used a less traumatic tech-
nique in which the paper strip was inserted
just into the orifice of the gingival crevice.
This technique was used by Wilson and
McHugh (1971). These differences in tech-
nique probahly affect the results. Data col-
lected with the deep intracrevicular tech-
nique may reflect the variable degree of
trauma involved and might even be only an
alternative to measuring pocket depth with a
probe.
 GINGIVAL FLUID CORRELATION 37

Interdental gingival biopsies have been obtained and nine sections from each were
extensively investigated by Bernier (1950). evaluated morphometricaUy. The percentage
All gingival tissues showed some histologic distribution of inflammatory round cells,
evidence of inflammation regardless of the collagen fibres, connective tissue cells and
clinical state. He concluded that since tissue blood vessels was studied. They found a
changes precede clinically detectable chan- positive correlation between the M Index
ges, to establish a clinical index of gingival and crevicular fluid, as well as between the
disease would be impractical. Brill (1960) M. Index and the degree of inflammatory
studied specimens from dogs with both cell infiltration. A high positive correlation
healthy and pathologically involved gingiva. also existed between the gingival fluid and
He demonstrated inflammatory cells scan- the round cell infiltration. A negative cor-
tily distributed beneath the crevicular epi- relation existed between crevicular fluid and
thelium in the clinically normal sections and the percentage of staitiable collagen fibres.
highly increased in number in the clinically In view of the existing confusion an in-
inflamed gingiva. He also found a relation- vestigation was undertaken to evaluate any
ship between gingival fluid measurements correlation between gingival fluid flow and
and the microscopic appearance of the tis- macroscopic and microscopic changes of
sue. Egelberg (1964) found a significant gingival tissue.
correlation between the size of the areas of
inflammation in clinically normal and in-
flamed gingiva and the amount of gingiva! Materials and Methods
exudate from three dogs. Subjects were 30 adult patients, for whom
Zachrisson and Schultz-Haudt (1968) re- treatment had not been started, randomly
cently suggested a classification of the de- selected from those attending the Depart-
gree of inflammation in clinically normal ment of Periodontology of the Royal Dental
and inflamed gingiva based upon a compa- Hospital of London. The study was made on
rative histologic study. The appearance of 30 sites, one from each subject, chosen
the pocket epithelium and the density and haphazardly in an endeavour to obtain a
distribution of the cell infiltration in the wide range of severity of inflammation and
connective tissue were used to evaluate the periodontal destruction.
degree of gingival inflammation. They found The papillae were scored according to the
a relationship between clinical and histo- Gingival Index (G.I.) of Loe and Silness
logical diagnosis in about 50 per cent of the (1963).
cases. AH clinically healthy cases exhibited Crevicular fluid was collected in the way
scantily distributed inflammatory cells. The described by Loe and Holm-Pedersen
investigators suggested that the degree of (1965). The gingiva was dried with the aid
inflammation should be classified histologic- of a stream of warm air and strips of filter
ally. paper (Whatman No. 4) cut to 1.5 mms.
Riidin et al. (1970) also measured gingival vidde and at least 10 mm. long were used.
fluid related to 30 maxillary and mandibular The tips of each strip were gently placed
teeth. They used filter paper strips with a jiust into the orifices of the crevices or
standardized notch at the tip, designed to pockets on both the mesial and distal aspects
ensure only minimal insertion into the of the interdental papilla parallel to the long
crevice midway between the papillae. The axes of the teeth. The strips were kept in
clinical severity of marginal inflammation place for three m'nutes, before being re-
was scored using the M Index. Biopsies were moved, allowed to dry, and stained with a
38 DANESHMAND
niohydrin solution (0.2 % ninhydrin in
acetone) for ten seconds. The mid-width
length of the coloured areas of the strips
was subsequently measured at the conclusion
of the experiment with a magnifying lens
graduated at 0.1 mm. intervals to the near-
est graduation. When making these measure-
ments no reference was made to the other
recorded parameters.
Following collection of exudate, the
depths of the pockets each side of the inter-
dental papilla were carefully measured to
the nearest half millimeter with a Fox perio-
dontal probe graduate at 1 mm. intervals.
As it was difficult to make G.L scores at
each side of the papilla, a mean figure of
fluid measurements and a mean figure of
pocket depth were calculated for each pa-
pilla.
After measuring pocket depths, the inter-
dental papilla was anaesthetised with 2 %
Lignoeaine plus 1:80,000 adrenaline solu-
tion. Special care was taken to inject remote
from the site of biopsy and to inject only
a minimal amount of fluid. A gingivectomy
incision was then made to free the vestibular
interdental papilla, care being taken to en-
sure that the incision contacted cementum
Fig. 1. Method of scoring HJstoiiogicaf Index.
Cf No break in contmuity of the crevicular epithelium:
absence of mfiammatory ceils.
1 No epitiieiia! break; sparse distribution of snfiam-
matory ceils.
2 Crevicular epitheliai disintegration; round ceiJ in-
fiitration not reaching basai iayer of tiie outer
gingjval epithieiium.
3 Disintegration of the crevicuiar epitiieiium; round
ceii i:nfii1raticn extendiing; to the basai iayer of the
outer gingival epithelium.
AND BRYAN WADE
beyond the apical limit of the junctional
epithelium. The specimen was fixed in 10 per
cent formal-saline, before being cut in half
vertically and each half embedded ctit side
down in paraffin Sections were cut at 6(j,
and collected at different levels starting from
the midline of the papilla. An attempt was
made to cut each hlock at five levels and
to collect four sections at each level thereby
producing twenty sections for evaluation,
but with some specimens the thickness was
insufficient to permit this number and fewer
had to be examined. The minimum number
of sections obtained from any specimen was
twelve. Sections were stained with haema-
toxylin and eosin.
The histological appearance was assessed
at XlOO magnification according to the
following criteria:
0 No break in continuity of the crevicular
epithelium; absence of inflammatory cells.
1 No epithelial break; sparse distribution of
inflammatory cells.
2 Crevicular epithelial disintegration; round
cell infiltration not reaching basal layer
of the outer gingival epithelium.
3 Disintegration of the crevicular epithe-
lium; round cell infiltration extending to
the basal layer of the outer gingival epi-
thelium (Fig. 1).
The highest score given for any section
examined will be referred to as the Histo-
logical Index (H.I.) for the particular papilla
from which the sections were obtained.
In addition the sections were evaluated
morphometricaUy using a graticule eye-
piece at X 100 magnification. Inflammatory
cells in the corium crossed by the horizontal
and vertical lines of the grid were counted.
A mean score for each papilla was cal-
culated by summating the scores and divid-
ing the total by the number of sections
examined. This will be referred to as the
Inflammatory Cell Index (I.C.L).
Regression and Correlation Coefficients
were calculated and scatter diagrams drawn.
 GINGIVAL FLUID CORRELATION 39

Reproducibility were different in 65 per cent, the difference

All assessments were made by one person was only 0.1 mm. in ten out of the thirteen;
(H.D.) Intra-examiner reproducibility was 0.2 mm. in two and 0.5 mm. in one. A
evaluated in different ways. Student t test showed t = 0.45; d.f. = 38;
0.60 < P < 0.70.
G.L Scores - One interdental papilla was
scored in each of ten other subjects chosen Histological Index — Ten sections, each from
at random. After scoring, a period of time a different papilla were re-scored. Repro-
during which other work was undertaken ducibility was one hundred per cent.
was allowed to lapse before the papillae
were scored again. This resulted in one Inflammatory Cell Index - This was re-
hundred per cent reproducibility. scored on the same ten sHdes and compared
with the previous counts. All counts were
Pocket Depth Measurements - Measure- different but the mean count at the first
ments were made either side of the selected measurements was 245.3 against 251.2 on
papilla in the same ten subjects and re- the second occasion. Application of a Stud-
measured when the G.I. was rescored. Sev- ent t test showed t = 0.13; d.f. = 18;
enty per cent of the measurements were 0.80 < P < 0.90.
identical. Of the six which varied, five did It can therefore be concluded that the
so by half a millimeter and one by a whole degree of reproducibility for each of the
millimeter. Application of a Student t test five parameters used was high and that no
revealed t = 0.02; d.f. = 38; P > 0.90, in- significant changes (P<0.05) could be
dicating that there was no significant varia- attributed to a lack of reproducibility.
tion in reproducibility of pocket depth mea-
surements.
Results
Gingival Fluid Measurements — The stained The results of the investigation are assem-
filter paper strips from ten subjects were bled in Table 1.
remeasured. Although the measurements
Histological Index and gingival fluid. Gin-
gival fluid when compared with changes as-
sessed by the more subjective method at
5 —
microscopic examination revealed some cor-
relation but not a very strong one (r =
+ 0.32; 0.05 < P < 0.10, Fig. 2).

Inflammatory Cell Index and gingival fluid.

Similar correlation was found between the
1 _ degree of round cell infiltration and gin-
gival fluid flow ( r = +0.34; 0.02 < P <
0.05, Fig. 3).

Histological Index and inflammatory index

Giagival Fluid (mm.)
Fig. 2. Scatter diagrara showing reiation
Histoiogicai Index and Qingivai Fluid.
with G.I. Interdental papillae which at the
clinical examination were assessed as having
between
slight inflammation (G.L = 1), moderate in-
 40 DANESHMAND AND BRYAN WADE

330 - |
310 _ •
310 _
290 _ •

290 .
270 - •

250 - 270 .
•
230 - 250 -
210 _ •

• 230 -
190 .. •
210.
170 - m

150 - S 190 .
IJO _ •<< &
• • * •
110 _ • .2 170 -
90 - m B 150 -
• •
70 - c
" 130
50 •
110 _
1 2 3 1 * 5 6 7 8
Gingival Fluid (mm.) 90 _
Fig. 3. Scatter diagram sfiowing reiation between in-
fiammatory Ceii index and Gingivai: Fiuid 70 _

50 il 1 1
1 2 3
GingiTal Index
3- Fig. S. Scatter diagram showing reiation between in-
fiammatory Ceii index and Gingival index.

flammation (G.I. = 2) and severe inflamma-

tion (G.I. = 3) all had inflammatory cell
infiltration in the microscopic sections. A
low correlation was observed between G.I.
scores and the Histological Index (r =
+ 0.32; 0.05 < P < 0.10', Fig. 4).
A comparable relationship was also ob-
served between the G.I. Index and the In-
I flammatory Cell Index (r = +0.26, 0.10 <
1 2 5 P < 0.20, Fig. 5).
( J i n g i v a l Index
Fig. 4. Scatter dJagrar^ showing reiation between His- ^ " ' " ' o ^ ' ™ ' Index and inflammatory cell
toiogicai Index and Gingivai Index. index with pocket depth. Pocket depth and
 GINGIVAL F i U I D CORRELATION 41

330

7 • • 310

290
6 •

• • 270
-^ 5
• • 250
X h • • • • •
230
u» • •
S 3 • • • • • 210
•o
• • •
H 190

o
170
1 -
Bm 150

1 1 1 a 130
1 2 3
110
Histologioal Index •90
Fig. 6. Scatter diagram; showfng relation between
Histoiogicai index and Pocket Depth. 70 -

50
the Histological Index showed virtually no
1 2 3 1 1 5 6 7 8
correlation (r = +0.01, P < 0.95, Fig. 6). Pocket depth (mm.)
Only a slight correlation between the Fig. 7. Scatter diagram showing reiation between In-
depth of the pockets and amount of inflam- fiammatOFy Ceil Index and Pocket Depth.
matory cell infiltration was found (r =
+ 0.20, 0.20 < P < 0.30, Fig. 7).
+ 0.48; P<0.01) existed between these
G.I. Index and gingival fluid. Gingival fluid parameters (Fig. 8).
flow increased with increasing G.L scores
(Table 1). G. I. Index with pocket depth. The average
A moderately strong correlation (r = of the pocket depth for 17 cases which

Table 1
Mean histological and inflammatory cell indices corresponding to G.I. and average
amounts of gingivai tluid and pocket depth of both mesiai and distal aspects of the
interdental papillae.
Histoiogicai infiamtnatory Gingivai
Pocket D'epth
index Ceil index G. i. Fiuid
(H. I.) (i. C. i.) (mm:,) (mm.)

17 2.52 160.63 1.95 3.61

10 2.70 166.21 3.11 4.37
3 3.D0 217.15 5.46 4.25

N = number of interdentai pspijllae assessed.

 42 DANESHMAND AND BRYAN WADE

7-

6-

1 -

Gingival Fluid (mm.)

Fig. 10. Scatter diagram showing reiation between
Gingivai Fiuid and Pocket Depth.

Gingival Index
Fig. 8. Scatter diagram showing reiation between scored G.I. = 1 was 3.61 whereas for 10
Qingival Fiuid and Gingiivai index. cases with G.I. = 2 was 4.37 and for 3
cases with G.I. = 3 was 4.25. However the
G.I. index when compared with pocket
depth showed a low degree of correlation
( r = +0.24, 1.10 < P < 0.20, Fig. 9).
7
Gingival fluid and pocket depth. Although
6 the mean figures suggested that there was a
greater amount of gingival fluid when the
5 pockets were deeper (Table 1), plotting the
actual figures (Fig. 10) showed no relation-
h ship (r = +0.O1; P < 0.90).

Histological Index with inflammatory cell

a,
index. The strongest correlation of all was
o found between the Histological and Inflam-
2
matory Cell Indices (r = +0.58, P < 0.001,
Fig. 11).
1

1 2
Gingival Index
Fig. 9. Scatter diagram showing relation
Gingi'vai index and Pocket Depth.
Discussion
5 Theoretically one would expect the amount
of fluid collected at the orifice of a crevice
between or pocket to be an expression of the degree
of permeability of the hlood vessels of the
 GINGIVAL FLUID CORRELATiON 43

330 readily be measured. Although the length of

any hreaeh io epithelial continuity can be
310 measured on a section, the surface area of
such a hreaeh is not easily measured. It is
290 - reasonable to suggest, however, that a valid
assessment of the severity of the inflam-
270 _ matory response would be made by examin-
ing several sections from a papilla cat in a
250 - linguo-facial plain and assessing the extent
of inflammatory cell migration towards the
230 outer epithelium as well as the extent 01 any
•a 2 1 0 _ pathological breach of the crevicular epithe-
lium. These considerations formed the basis
of the Histological Index (H.I.) evolved for
this study.
Possibly the degree of capillary permea-
bility might also be evaluated by counting
the number of cells migrating from the ves-
I ^50 - sels as well as the distance of migration.
H
:H 130 - Combining these features and the epithelial
factor in one index would be difficult and
110 for this reason an Inflammatorj' Cell Index
(I.C.I.) was developed. As the I.C.I, only
90 - considered one histological aspect of the in-
flammatory phenomenon one would not ex-
70 - pect it to be as true an index as the H.I. and
this was borne out by the fact that although
50 there was a positive correlation between the
two indices it was far removed from unity
( r = +0.58).
Histological Index Inflammation is usually defined as the
Fig. 11. Scatter diagram showing reiation between vascular and cellular response to an irri-
HistoJogicai index and Iniiammatory Ceii Index. tatit. As such response can only be deter-
mined by histological examination it seems
logical to accept the postulate of Zachris-
son and Schultz-Haudt (1968) that the de-
gitigival corium and the permeability of the gree of inflammation should be classified
epithelium or extent of any actual break in histologically. There are, however, many
the continuity of this tissue. Measuritig ca- aspects of the vascular and cellular response
pillary permeability in biopsy specimens which cannot easily be scored and even if
from humans would be extremely difficult they could it is by no means certain which
but this feature might reasonably be ex- changes represent a more severe response or,
pected to bear a strong relation to the expressed another way, which will result in
extent of inflammatory cell infiltrations in more rapid recovery of the tissues once
chronic untreated lesions. Similarly the the irritant is removed and a favourable en-
extent of epithelial permeability cannot vironment achieved. The results of the pres-
44 DANESHMAND AND BRYAN WADE
ent investigation show that the index based
on what might be regarded as the extent of
inflammatory involvement and that quan-
titating the number of extravasated cells
were not measuring the same phenomenon
to the same degree. This highhghts only one
aspect of measuring the severity of inflam-
matory involvement by histological means.
Even if a suitable and aceurate parameter
could be developed there is still the diffi-
culty of obtaining material for histological
evaluation. This is a major problem and it
is obvious that an index which does not
necessitate excision of tissue has much to
commend it. The need seems, therefore, to
be the development of a histological index
which accurately reflects the situation and
then to determine which clinical index cor-
relates most closely with it. It is interesting
to note that whereas the mean amount of
gingival fluid ranged from 0.2-7.8 mm. the
H.I. was always either 2 or 3 (Fig. 2).
Comparison between the various studies
is only possible where the results were anal-
ysed by the calculation of correlation coef-
ficients. Even such comparison is tenuous as
investigators used different indices for eva-
luating both the microscopic and macro-
scopic state of the gingivae and measured,
as well as collected, gingival fluid in differ-
ent ways.
Rlidin et al. (1970) found a correlation
coefficient of -1-0.693 between the extent of
round cell infiltration and the severity of gin-
givitis determined by the M index; Orban et
al. (1970) of -1-0.68 using the PDI; Stallard
et al. (1970) of 0.62, 0.65 and 0.68 in three
groups again using the PDI, whilst the pres-
ent study revealed one of -fO.32 between
the H.I. and the G.I. and -t-0.26 between
the i.C.I. and G.I. Explanation of these
differences is difficult as the histological
methods of Riidin et al. (1970) were similar
to the I.C.I, of the present study, whereas
those of Orban et al. (1970) and Stallard
et al. (1970) were based on a subjective as-
sessment and more comparable to the H.I.
of the present study.
Correlation between the microscopic eva-
luations and measurement of collected gin-
gival fluid revealed a coefficient of +0.50 in
the study of Orban and Stallard (1969),
+ 0.746 in that of Rlidin et al. (1970), again
+ 0.501 (Orban et al. 1970) in what was
probably a further report of the 1969 study,
+ 0.51 and +0.55 in that of Stallard et al.,
(1970) and +0.32 with the H.I. and +0.34
with the I.C.I, in the present study. Egelberg
(1964) found figures of +0.67, +0.71 and
+ 0.78 in each of three dogs where the
comparison was with the area of round cell
infiltration.
Of the four studies in which both the
macroscopic and microscopic gingiva! state
were related to the amount of gingival fluid
it was found that the correlation with fluid
was greater when assessment of inflamma-
tory involvement was based on a count of
cells. Clinical assessment showed a stronger
correlation than microscopic evaluation
which was subjective and when area of
inflammatory involvement was assessed by
both the extent of cellular infiltration and
destruction of pocket epithelium the cor-
relation was of equal strength.
A further complicating factor was that the
collection of fluid was by the intracrevicular
method in the studies which showed a
stronger correlation with the gingival score
and by the orifice method when the cor-
relation between microscopic score and gin-
gival fluid was stronger.
As the differences in strength of the re-
spective correlations was not great it cannot
be said that any of the studies have demon-
strated a truer representation of the histo-
logical changes by either a subjective clinical
evaluation or by the measurement of gin-
gival fluid.
A subjective clinical assessment using any
of the advocated indices is far easier and
less time consuming than the collection and
 GINGJVAL FLUID
measurement of gingival fluid and would
seem to be the wisest parameter for use in
many clinical studies at the present time.
It is possible that the gingival fluid index
may be more valuable when making wound
healing studies after surgical assault. This is Brill, N. & Bjorn, H. 1959. Passage of tissue
a facet which requires further study.
Studies relating the amount of gingiva!
fluid to estimates of gingival inflammation
assessed by clinical criteria have tended to
assume that the latter are an accurate re-
presentation of the degree of inflammatory
involvement (Mann 1963, Wilson & Me
Hugh 1969). The revelation in other studies
(Orban et al. 1970, Riidin et al. 1970, Stal-
lard et al. 1970 and preseot study) that the
correlation between histological indices and
gingival indices may range from +0.26-0.69
suggests that gingival indices only partially
reflect assessment of the changes observed
at microscopic level. Evaluation of the lat-
ter is stOl, however, far from satisfactory
and in view of this it would still seem that
the comparatively simple clinical indices are
at the moment those of choice for many
clinical studies.
Part of a report submitted to the University Loe, H. & Silness, J. 1963. Periodontal disease
of London in partial fulfilment of the re-
quirements for the degree of Master of
Science in Periodontology.
References
Bernier, J. L. 1950. The histologie changes of
the gingival tissues in health and periodontal
disease. Oral Surg. 3; 1194-1199.
Bjorn, A., Koch, G. & Lindhe, J. 1965. Evalua-
tion of gingival flaid measurements. Odont. Orban, J. E. & Stallard, R. E. 1969. Gingival
Revy 16: 300-307.
Brill, N. & Krasse, B. 1958. Passage of tissue
fluid into the clinically healthy gingival Orban, J. E., Stallard, R. E. & Bandt, C. L.
pocket Acta Odontol. Scand. 16: 233-245.
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CORRELATION 45
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46 DANESHMAND AND BRYAN WADE

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Address;
A. Bryan Wade
Royal Dental Hospital
Leicester Square
London, WC2H 7LJ
England